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Phase I/II trial of X-396 in patients (pts) with ALK+ non-small cell lung cancer (NSCLC): Correlation with plasma and tissue genotyping and response to therapy (tx)

Date

09 Oct 2016

Session

NSCLC, metastatic

Presenters

Leora Horn

Citation

Annals of Oncology (2016) 27 (6): 416-454. 10.1093/annonc/mdw383

Authors

L. Horn1, H. Wakelee2, G. Blumenschein3, K. Reckamp4, S. Waqar5, C.A. Carter6, B.J. Gitlitz7, J.R. Infante8, R.E. Sanborn9, J. Neal2, J.P. Gockerman10, G. Dukart11, K. Harrow11, C. Liang11, J.J. Gibbons11, J. Hernandez12, T. Newman-Eerkes12, L. Lim12, C. Lovly1

Author affiliations

  • 1 Thoracic Oncology, Vanderbilt Ingram Cancer Center, 37232-6307 - Nashville/US
  • 2 Medicine-oncology, Stanford University Medical Center, Stanford/US
  • 3 Thoracic Head & Neck Oncology, MD Anderson Cancer Center, Houston/US
  • 4 Department Of Medical Oncology, City of Hope, Duarte/US
  • 5 Division Of Oncology, Washington University School of Medicine, St Louis/US
  • 6 Thoracic Oncology, National Naval Medical Center (NNMC), Bethesda/US
  • 7 Department Of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles/US
  • 8 Medical Oncology, Sarah Cannon Research Institute, Nashville/US
  • 9 Thoracic Oncology Program, Providence Portland Medical Center, Portland/US
  • 10 Oncology, Novella Clinical, Morristown/US
  • 11 Oncology, Xcovery Holding Company, Palm Beach Gardens/US
  • 12 Clinical Operations, Resolution Bioscience, Bellevue/US
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Resources

Abstract 3636

Background

X-396 is a novel, potent ALK small molecule TKI with additional activity against MET, ABL, Axl, EPHA2, LTK, ROS1 and SLK. We report on data from pts that includes detection/monitoring of ALK fusions by plasma next-generation sequencing (NGS).

Methods

Pts with advanced solid tumors and ECOG PS 0-1 were tx'd with X-396 225 mg qd on a continuous 28-day schedule. In expansion phase, required to have measurable ALK+ NSCLC. Asymptomatic brain metastases allowed. Tissue confirmed centrally via FISH or IHC. Targeted NGS of cfDNA was performed retrospectively at baseline and on study and compared with tissue results.

Results

As of April 15, 71 pts (35 men, 36 women) enrolled. Median age 54 (20-79) yrs, 66% had ECOG PS 1. 37 ALK+ NSCLC pts tx'd at doses ≥ 200 mg evaluable for response; partial response (PR) achieved in 21 pts (76%), stable disease (SD) in 8 (22%). In crizotinib-naïve pts (n = 8), responses in 7 (88%). In 20 pts with prior crizotinib but no other ALK TKI, 12 (60%) had PR, 7 (35%) SD. Tissue via FISH (F) and Plasma genotyping (P) available on 42 pts: RR for 25 F + P+ pts 52%, 6 F-P- pts 0%, 11 F + P- pts 55%. Concordance between F and P was 74%. Tissue via NGS (N) and P genotyping available on 13 pts with 27 mutations and fusions identified; RR for 18 T + P+ pts 78%, 4 T-P+ pts 100%, 5 T + P- pts 75%. 2 samples were T-P-. Concordance between N and P was 74%. Responses were seen in pts with L1196M, G1296M, G1202R, and T1151M resistant mutations. Serial sequencing demonstrated decrease in ALK in responding pts and increase at time of progression. CNS responses observed in crizotinib naïve and resistant pts. Median duration of tx in the 37 evaluable ALK+ pts is 23.6 wks, longest being 139+ wks. Most common drug-related AEs (>20% of pts) included rash (48%), nausea (28%), fatigue (25%), vomiting (23%). Most AEs were Grade (G) 1-2. Most common G3 tx-related AE was rash (8 pts). No G3 related GI AEs or liver enzyme elevations reported.

Conclusions

X-396 is well-tolerated and induces responses in crizotinib-naïve & resistant ALK+ NSCLC pts, and pts with CNS lesions. Plasma sequencing may be used to select pts for tx and monitor for response and development of acquired resistance. Enrollment ongoing.

Clinical trial identification

NCT01625234

Legal entity responsible for the study

Xcovery Holding Company

Funding

Xcovery Holding Company

Disclosure

L. Horn: Consulting uncompensated: Bayer, Xcovery, BMS, BI Consulting compensated: Merck, Lilly, Genentech. Research funding: AZ. H. Wakelee: consultant and honorarium: Peregrine, Novartis, ACEA, Pfizer grants/research support: Novartis, Pfizer, BMS, Xcovery, Celegene, Roche, Medimmune, Lilly. G. Blumenschein: Consultant: Clovis, BMS, Bayer, Celgene, Abbvie Grants: Merck, Bayer, BMS, Celgene, Novartis, Xcovery, AZ. K. Reckamp: Ariad consultant and research funds to institution. Xcovery research funds to institution. C.A. Carter: Honoraria, Speakers Burea, Research funding: BMS. B.J. Gitlitz: speakers bureau for Lilly and Genentech. R.E. Sanborn: Institutional support: Bristol-Meyers Squibb, Medimmune; Research support: Merck Advisory boards: Peregrine Pharmaceuticals, Seattle Genetics; travel: BMS, Five Prime Therapeutics. J. Neal: Consulting: Clovis, CARET, Nektar, BI Research: Genentech, Merck, Arqule, Novartis, Exelixis, BI, Nektar. J.P. Gockerman: Employee Novello. G. Dukart: Consultant Xcovery. K. Harrow, C. Liang, J.J. Gibbons: Employee and stockholder of Xcovery. J. Hernandez: Employee and stockholder of Resolution Bio. T. Newman-Eerkes, L. Lim: Employee and stock holder of Resolution Bio. C. Lovly: consultant for Pfizer, Novartis, Genoptix, Sequenom, Clovis, Ariad, and Guidepoint invited speaker for Abbott and Qiagen. All other authors have declared no conflicts of interest.

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